Provider First Line Business Practice Location Address:
1170 S STATE ST
Provider Second Line Business Practice Location Address:
BOX 729
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-441-7345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006